Physician Compare National (NPI:1720038151)

HEALTHCARE PROVIDER: CHARLES THORNTON SLACK M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1720038151
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1557306339
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20050622000680
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SLACK
	Individual professional last name
Provider First Name	CHARLES
	Individual professional first name
Provider Middle Name	THORNTON
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL AT DALLAS
	Individual professional's medical school
Graduation Year	1990
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	GENERAL SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	GENERAL SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1105 N CENTRAL EXPWY
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 370
	Group Practice or individual's line 2 address
City	ALLEN
	Group Practice or individual's city
State	TX
	Group Practice or individual's state
Zip Code	750136111
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2144956464
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y